Page 224 - E-Rate 2020-21 Workbook

OPERATIONAL SPIN CHANGE (CONTINUED)
1 Applicant Name
2 Funding Year

3 Funding Request Number (FRN)

14 Provide the following two items:
A detailed explanation of the need for the change: (Breach of Contract, Gone Out of
1 Business or Other). Also, if the new service provider requested was not the second highest
bidder on the final Bid Evaluation Sheet attached, include an explanation.

Attach the final bid evaluation worksheet (a listing of the bid weighting factors and individual
vendors' scores for all vendors that participated in the original competitive bidding process)
2 for the services requested in FRN(s) associated with the SPIN change. If applicable, provide a
statement that there was only one or no bids received.

AUTHORIZATION

I hereby authorize Kellogg & Sovereign Consulting, LLC (KSLLC) to change the service provider
on our E‐rate Form 471 application as indicated above.

CHECK ALL THAT APPLY:

I have attached our final bid evaluation worksheet (bid scoring grid)
I have attached a copy of the proposal which I approve from the new service provider
I have attached a statement that I only received one or no bids with an explanation

I authorize KSLLC to prepare an E‐rate contract for the new provider for signature
OR I have attached a signed agreement with the new provider

Authorized Signature Title Date

July 2019